Spasticity In Stroke Patients Research Articles

Poster 249: Health Utility and Quality of Life Following Botulinum Toxin Type A in Repeated Doses for the Treatment of Focal Upper-Limb Spasticity in Stroke Patients: A Multicenter Open-Label Study

Objective: To measure the effects of repeated intramuscular botulinum toxin type A (BTX-A) for focal upper-limb spasticity of stroke patients on health utility and quality of life. Design: Multicenter, open-label, repeated-dose study. Setting: 35 North-American stroke research centers. Participants: 279 stroke patients. Intervention: Up to 5 intramuscular BTX-A (100–600U) injections given to wrist, finger, and elbow flexors. Main Outcome Measures: The Stroke-Adapted Sickness Impact Profile (SIP-SA; score range, 0 [no dysfunction] to 100 [maximum dysfunction]) and the EuroQol (EQ-5D) visual analog score (VAS; score range, 0 [worst imaginable health] to 100 [best imaginable health]) were evaluated at baseline, and weeks 6, 12, 24, 30, 36, and 48 after first intervention.

Treatment of upper extremity spasticity in stroke patients by focal neuronal or neuromuscular blockade: a systematic review of the literature.

Studies published from January 1966 until October 2000 on the clinical effects of focal neuronal and neuromuscular blockade in post stroke upper limb spasticity were identified. Twelve studies were included and evaluated on 13 methodological criteria. Ten studies on Botulinum toxin type A (BTX-A) treatment were found (of which 4 were randomised controlled trials (RCTs) and 6 were uncontrolled observational studies) as well as one uncontrolled observational study on phenol blockade of the subscapular muscle and one on alcohol blockade of the musculocutaneus nerve. The homogeneity of the patient groups with regard to diagnosis and their comparability with regard to functional prognosis and other sources of bias were generally unsatisfactory. Only two RCTs met predetermined criteria of minimal validity. There is evidence of effectiveness of BTX-A treatment on reducing muscle tone (varying between 0.8 and 2.0 points on the modified Ashworth scale) and improving passive range of motion at all arm-hand levels in chronic stroke patients for approximately 3-4 months. There is also preliminary evidence of a synergistic effect of concomitant electrostimulation. Taking into account a critical maximum dose of 100 MU Botox" (300-500 MU Dysport) for preserving active finger flexion, BTX-A treatment seems to be a safe focal spasmolytic treatment. Effectiveness of BTX-A treatment on improving functional abilities could not be convincingly demonstrated, although two subgroups may be identified that might specifically benefit at a functional level: (1) patients with mild spasticity and a potential for voluntary extensor activity and (2) patients with severe spasticity suffering from problems with positioning and taking care of the affected arm and hand. Larger controlled studies are needed to compare the effectiveness of BTX-A with other focal spasmolytic techniques paying special attention to individual goal assessment, the (duration of) functional benefits, co-treatment and aftercare, side-effects and cost-effectiveness.

Reliability of the Modified Ashworth Scale in the Assessment of Lower Limb Spasticity in Stroke Patients

In stroke rehabilitation, spasticity is a common motor disorder, which often requires treatment and rehabilitation. The Ashworth scale was originally published in 1964 (Ashworth, 1964) and later modified (Bohannon, 1987). The scale is a sixpoint rating scale ranging from 0 (no increase in muscle tone) to 5 (affected part rigid in flexion or extension). However the inter- and intra-rater reliability still remains equivocal. The purpose of this study was to investigate the reliability of the scale specifically in the assessment of lower limb spasticity. Twenty stroke patients were tested at two weeks, and 20 at 12 weeks, but four patients were included on each occasion, giving a total of 36 patients in the trial. The age range was 62 to 90 years, with 17 men and 19 women; there were equal numbers of right and left hemiplegias. The researcher (MB) and an independent assessor (IA) performed the assessments which were one hour apart for inter-rater reliability (MB and IA) and one week apart for intra-rater reliability (MB twice). The order of testing was reversed for half the patients to control for order effect. The muscle groups tested were gastrocnemius, soleus and quadriceps on the hemiplegic side. A standardised procedure

Input-output properties of the soleus stretch reflex in spastic stroke patients and healthy subjects during walking

The input-output properties of the soleus stretch reflex during walking and sitting were examined in 11 spastic stroke patients and 10 healthy subjects. In the early swing phase, the threshold of the input-output relation was significantly lower in the patient group - on average 108°/s compared to 309°/s in the control group (P=0.02). The slope of the input-output properties was unchanged in patients and in control subjects (P=0.39). In stroke patients we found a minor, but significant, difference in threshold with 108°/s in the early swing phase compared to 74°/s in sitting position at matched TA EMG activity (P=0.01). Furthermore, we found an unchanged slope of 0.25μVs/° during walking and 0.28μVs/° in the sitting position (P=0.21). In contrast, control subjects showed a large difference in the threshold in the early swing phase during walking (309°/s) compared with findings in the sitting position at a matched TA EMG activity (71°/s, P=0.004). The slope was unchanged during walking and when the subject was sitting (P=0.22). There was a significant correlation between clinical spasticity score and stretch reflex threshold in the early swing phase (P=-0.61, P=0.04) and between clinical spasticity score and the slope in the early swing phase (P=0.72, P=0.009). It is concluded that in the early swing phase, the markedly reduced soleus stretch reflex threshold was preventing the stroke patients from making fast dorsiflexion of the foot at the ankle joint and thereby impairing the walking speed.

Input-output properties of the soleus stretch reflex in spastic stroke patients and healthy subjects during walking

Input-output properties of the soleus stretch reflex in spastic stroke patients and healthy subjects during walking

The efficacy of thermocoagulation of the tibial nerve and a polypropylene ankle-foot orthosis on spasticity of the leg in stroke patients: results of a randomized clinical trial

Objective: To investigate the efficacy of thermocoagulation of the tibial nerve and a polypropylene ankle-foot orthosis (AFO) on spasticity of the leg in stroke patients with a spastic equinus or equinovarus foot. Design: A placebo-controlled randomized clinical trial with a 2 x 2 factorial design. Setting: Outpatient clinic, Department of Rehabilitation Medicine, Academisch Ziekenhuis Vrije Universiteit Amsterdam. Subjects: 60 stroke patients (17 women, 43 men), with a median age of 58 years and a median period of 34 months poststroke, with at least independent walking capacities at home. Main outcome measures: Change in spasticity, muscle tone, ankle clonus, Achilles tendon reflex, ankle range of motion (ROM), motor function of the leg, and balance, measured six and 15 weeks after randomization. Results: Thermocoagulation, rather than the AFO, reduced spasticity, muscle tone, Achilles tendon hyperexcitability, and ankle clonus. At six-week follow- up, the effects on Achilles tendon reflex and ankle clonus were the most pronounced; reflex excitability was reduced in 59% of the patients treated with thermocoagulation, as compared to 14% of the placebo-treated patients, whereas ankle clonus was reduced in 55% and 0% of the patients, respectively. Reduced spasticity was found in 35% of the actively treated, as compared to 10% of the placebo-treated patients. For muscle tone, the percentages of improved patients in each group were 45% and 24%, respectively. After 15 weeks the differences between the groups were smaller. No clinically relevant improvement was found with regard to ROM, the Fugl-Meyer lower extremity and balance scores, walking ability and walking speed. Conclusion: Thermocoagulation is effective for the reduction of spasticity in stroke patients with a spastic equinus or equinovarus foot. No effect on spasticity of the AFO could be demonstrated. When the efficacy of thermocoagulation and the AFO are judged in terms of functional abilities, however, the effects seem of little value.

Electrophysiologic Evaluation of Muscle Spasticity in stroke patients

Electrophysiologic Evaluation of Muscle Spasticity in stroke patients

Relationship between static muscle strength deficits and spasticity in stroke patients with hemiparesis.

The purpose of this retrospective investigation was to determine whether a relationship exists between static strength deficits in the shoulder medial (internal) rotator and elbow flexor muscles and spasticity in these muscles or their antagonists. We reviewed the records of the first 50 stroke patients with hemiparesis who met the entry criteria for the study and who were admitted over a four-month period of time. Static muscle strength was measured by hand-held dynamometry. Spasticity was graded on the Ashworth scale. Kendall's tau correlations were calculated between static muscle strength deficits and spasticity. Static strength deficits of the shoulder medial rotator and elbow flexor muscles were correlated (p less than .01) with the agonist muscles' spasticity, but not with the antagonist muscles' spasticity. Muscle group spasticity and strength deficits, therefore, appear to be covarying manifestations of cerebrovascular accidents. Clinicians, thus, may interpret an agonist muscle's capacity for force production in light of its own tone rather than that of its antagonist.

Therapeutic Exercise for Spasticity in Stroke Patients.

Therapeutic Exercise for Spasticity in Stroke Patients.

Dantrolene Effectively Reduces Spasticity in Stroke Patients

Dantrolene Effectively Reduces Spasticity in Stroke Patients

Perceptual Trace Development during Motor Skill Acquisition in Stroke Patients

The hypothesis that stroke patients could learn a perceptual motor skill by developing a strong perceptual trace with practice was tested. Ten spastic stroke patients and sixteen normal subjects were observed while they learned a novel self-paced linear displacement task. The criterion movement was the displacement of an object with the affected leg (in the case of stroke patients) and left leg (in normal subjects), to a designated target. Visual, auditory, kinesthetic as well as knowledge of result information was available to the subjects. The results showed that stroke patients were able to reduce their movement errors as a function of practice by developing and strengthening their perceptual trace. This technique may be adapated for the modification of the motor behaviour of stroke patients.